Mental health care in N.H. has reached critical point

Tuesday

Apr 27, 2010 at 2:00 AM

I am currently in my last semester at the University of New Hampshire and will be graduating with my bachelor's degree in social work in May. Since September 2009, I have been given the amazing opportunity of interning at one of New Hampshire's 10 Community Mental Health Centers, Community Partners. I shadow members of the Intensive Community Support Program, which involves working with individuals of Strafford County living with severe and persistent mental illness. Within my past seven months at Community Partners, I have found that working with this population of people takes much empathy, patience and strength, but could not be more rewarding.

April 23 — To the Editor:

I am currently in my last semester at the University of New Hampshire and will be graduating with my bachelor's degree in social work in May. Since September 2009, I have been given the amazing opportunity of interning at one of New Hampshire's 10 Community Mental Health Centers, Community Partners. I shadow members of the Intensive Community Support Program, which involves working with individuals of Strafford County living with severe and persistent mental illness. Within my past seven months at Community Partners, I have found that working with this population of people takes much empathy, patience and strength, but could not be more rewarding.

Mental illness is a prevalent condition for up to 253,500 (26 percent) of adults in New Hampshire.

With proper treatment, many of these individuals are functioning members of society, with many achievements, and lead independent lives. For the rest of this group, services from community mental health centers such as Community Partners are imperative for managing their illness and residing in the community. Interning with the ICSP team, I have witnessed some of the more low-functioning people with mental illness of Strafford County and how important Community Partners' role is in their lives.

With the many state operating budget cuts already made in the past few years to mental health care, CMHCs have become primarily responsible for ensuring people with severe mental illness are receiving the services and basic needs to survive. Responsibilities includes visiting clients weekly, daily, or up to several times a day to: supervise with medications; prompt clients with the basic activities of daily living (personal hygiene, household care); provide strategies to manage symptoms; provide community outings and socializing opportunities; and referrals to needed services. The CMHCs in New Hampshire serve up to 50,000 people each year with diverse mental health disorders.

Most of the adults I have engaged with either do not have families or the support from their families to help them with all the fundamentals of life. Community Partners and the ICSP team allow clients to live in the community and prevent them from harming themselves or behaving in ways that could place them in a state hospital or, worse, jail. On Oct. 15, 2009, a Medicaid cut was made by the Department of Health and Human Services to mental health-care providers. Medicaid contributes approximately 75 percent of combined N.H. Community Mental Health Centers revenue. This cut has put a limit on the number of payable hours adults may be seen by functional support specialists who work with clients on their basic needs, outside of the center. This means that FFS workers can only bill for 2.5 hours spent with an individual client each day. Although 2.5 hours with one client may sound sufficient, it is not nearly enough when considering how long it can take to clean an apartment, prepare meals, run errands, travel to appointments and travel to other activities around the area. I have seen the difficulties this cap has caused, but the professionals at Community Partners are working diligently (even taking sacrifices with their own time and payment) to provide the best care possible for their clients.

Unfortunately, this is not the last of the budget cuts CMHCs will see this year. Last year, $93 million was given to serve Medicaid recipients seen by the 10 CMHCs. The amount has been reduced to $91 million this year, even as the centers have seen a 13 percent increase in the number of Medicaid recipients. According to the Community Mental Health Centers in New Hampshire report, Financial Performance and Condition, by Nancy Kane, Medicaid payment reductions will reach $8 million for the fiscal year 2010. As shown, cuts have already put a strain on the mental health care delivery system, however with further cuts, clients are going to directly feel the burden of stricter eligibility requirements, longer wait times, and further time reductions spent with therapists, counselors, and FFS workers.

The clients I have met at Community Partners have inspired me to advocate for people with severe mental illness. People with severe mental illness are often overlooked for they can be, at times, difficult to handle and empathize with. By looking past the odd behavior exhibited by some, I have seen the appreciation, intelligence and compassion of these individuals. The stigma associated with having a mental illness prevents many with mental illness from speaking out on mental health care issues. Therefore, I encourage those who have the voice and who believe that people with mental illness are no different than those with other medical disorders — to speak out for this under recognized population. There are several things that you can do to help:

1. Contact local legislators. Ask them to reject further cuts to mental health care.

2. Sign the NAMI N.H. Citizen Petition. The petition asks the governor and the state Legislature to reject any proposals for future budget cuts that will reduce mental health care. NAMI N.H.'s goal is to receive 10,000 signatures by April 30.

3. Attend the Mental Health Rally at 3 p.m. May 4 on the N.H. Statehouse lawn.

Information on the Citizen Petition, Mental Health Rally and mental illness can be found at www.naminh.org/action.php.

With further budget cuts, people with mental illness will suffer. Communities will see many costs due to the reduction of services that have been successfully keeping these individuals healthy, off the streets, and out of the courts, jails, and hospitals. With the absence of further reductions to mental health services, we can be confident that the people of N.H. with mental illness are receiving the help they need to sustain healthy living in our local communities.

Heather Hartshorne

Dover

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